Study finds patients with complex fibroadenomas can avoid surgery

Complex fibroadenomas have a low incidence of malignancy, so women with this condition can be more conservatively treated and avoid surgical biopsy, according to a new study by a team of researchers from the Hadassah-Hebrew University Medical Center in Jerusalem.

A fibroadenoma is a benign growth of the breast that is common in young women. They are not usually associated with breast cancer, and are often diagnosed with simple ultrasound-guided, non-surgical biopsy. Complex fibroadenomas are a subtype of fibroadenomas. They are also benign, but they have calcifications and small cysts that make their pathology more complex than simple fibroadenomas, prompting many doctors to recommend surgical removal to ensure that the fibroadenoma is not malignant.

“There is a lack of information or guidelines in the medical literature about the management of complex fibroadenomas, causing a dilemma for doctors with patients who have these lesions. Because the management of these patients is not clear, there is a tendency to excise them on surgery following a needle biopsy,” said Miri Sklair-Levy, MD, lead author of the study.

For the study, the researchers evaluated the clinical and imaging presentations of biopsy-proven complex fibroadenomas in 63 patients, compared pathologies and sizes of the lesions, and then followed up after two years. They found that only one out of the 63 patients with complex fibroadenomas had a malignancy, and that the patient with a malignancy had already shown previously.

“The findings from our study showed that complex fibroadenomas can be treated similar to simple fibroadenomas, meaning follow-up without the need to excise the lesions surgically. The exception to this practice would be if some atypical high-risk lesions are found, as in the case with the one patient in our study. In those situations, the complex fibroadenomas should be surgically excised to rule out malignancy,” said Dr. Sklair-Levy.

The full results of this study appear in a recent issue of the American Journal of Roentgenology.